Carini Fabrizio, Longoni Salvatore, Pisapia Valeria, Gatti Gianbattista, Monai Dario, Porcaro Gianluca
Department of Surgery and Translational Medicine, University of Milan-Bicocca, Monza, Italy.
Ann Stomatol (Roma). 2014 Oct 25;5(Suppl 2 to No 2):1-9. eCollection 2014 Oct-Dec.
The change in anatomy and physiology resulting from radical mandible surgery is often exacerbated by radiation therapies that make the mucosa atrophic and susceptible to irritation and ulceration rendering the task of areating functional complete dentures for edentulous subjects very challenging to prosthodontists. The aim of this study is to describe an implant supported denture rehabilitation in an edentulous hemimandibulectomized patient with a singular prosthetic design in order to compensate for the lack of a condylar process.
The subject of the clinical case, had a history of squamous cell carcinoma of the right tonsillar region for which it was subjected to a hemimandibulectomy and was primarily rehabilitated with an over denture mounted onto a bar furnished by a resin condylar eminence in articulation with the glenoid fossa of the upper denture. The need to provide greater stabilization for the upper prosthesis led to a maxillary implant insertion and to the realization of a new joint connection that was constituted inferiorly by a titanium condyle and superiorly by a teflon acetabulum.
The prosthetic balance guaranteed by the second rehabilitation greatly affected the biomechanics of mastication leading to a reduction of eccentric interferences, a stabilization of centric occlusion, and a lowering of intensity contraction by masticatory muscles. This difference is well represented by two and three-dimensional plans obtained from the application of a T-Scan III device.
The rehabilitative solution proposed was effective in resolving the lateral deviation, in relieving masticatory and speech discomfort, as well as restoring an aesthetically acceptable appearance in a hemimandibulectomized and not reconstructed patient.
根治性下颌骨手术导致的解剖结构和生理功能变化，常因放射治疗而加剧，放射治疗会使黏膜萎缩，易受刺激和溃疡，这给修复科医生为无牙患者制作功能性全口义齿带来了极大挑战。本研究的目的是描述一种为半侧下颌骨切除的无牙患者设计的种植体支持式义齿修复方案，采用独特的修复设计以弥补髁突缺失。
该临床病例的患者有右侧扁桃体区鳞状细胞癌病史，接受了半侧下颌骨切除术，最初使用覆盖义齿进行修复，义齿安装在由树脂髁突隆起与上颌义齿关节窝相连的杆上。为了为上颌修复体提供更大的稳定性，进行了上颌种植体植入，并实现了一种新的关节连接，其下方由钛制髁突构成，上方由聚四氟乙烯髋臼构成。
第二次修复所保证的修复平衡极大地影响了咀嚼生物力学，减少了偏侧干扰，稳定了正中咬合，并降低了咀嚼肌的收缩强度。通过应用T-Scan III设备获得的二维和三维平面很好地体现了这种差异。
所提出的修复方案有效地解决了侧向偏斜问题，缓解了咀嚼和言语不适，同时在半侧下颌骨切除且未进行重建的患者中恢复了美观的外观。
